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Health-Related Quality of Life Impacts Mortality but Not Progression to End-Stage Renal Disease in Pre-Dialysis Chronic Kidney Disease: A Prospective Observational Study

Author

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  • Mark D Jesky
  • Mary Dutton
  • Indranil Dasgupta
  • Punit Yadav
  • Khai Ping Ng
  • Anthony Fenton
  • Derek Kyte
  • Charles J Ferro
  • Melanie Calvert
  • Paul Cockwell
  • Stephanie J Stringer

Abstract

Background: Chronic kidney disease (CKD) is associated with reduced health-related quality of life (HRQL). However, the relationship between pre-dialysis CKD, HRQL and clinical outcomes, including mortality and progression to end-stage renal disease (ESRD) is unclear. Methods: All 745 participants recruited into the Renal Impairment In Secondary Care study to end March 2014 were included. Demographic, clinical and laboratory data were collected at baseline including an assessment of HRQL using the Euroqol EQ-5D-3L. Health states were converted into an EQ-5Dindex score using a set of weighted preferences specific to the UK population. Multivariable Cox proportional hazards regression and competing risk analyses were undertaken to evaluate the association of HRQL with progression to ESRD or all-cause mortality. Regression analyses were then performed to identify variables associated with the significant HRQL components. Results: Median eGFR was 25.8 ml/min/1.73 m2 (IQR 19.6–33.7ml/min) and median ACR was 33 mg/mmol (IQR 6.6–130.3 mg/mmol). Five hundred and fifty five participants (75.7%) reported problems with one or more EQ-5D domains. When adjusted for age, gender, comorbidity, eGFR and ACR, both reported problems with self-care [hazard ratio 2.542, 95% confidence interval 1.222–5.286, p = 0.013] and reduced EQ-5Dindex score [hazard ratio 0.283, 95% confidence interval 0.099–0.810, p = 0.019] were significantly associated with an increase in all-cause mortality. Similar findings were observed for competing risk analyses. Reduced HRQL was not a risk factor for progression to ESRD in multivariable analyses. Conclusions: Impaired HRQL is common in the pre-dialysis CKD population. Reduced HRQL, as demonstrated by problems with self-care or a lower EQ-5Dindex score, is associated with a higher risk for death but not ESRD. Multiple factors influence these aspects of HRQL but renal function, as measured by eGFR and ACR, are not among them.

Suggested Citation

  • Mark D Jesky & Mary Dutton & Indranil Dasgupta & Punit Yadav & Khai Ping Ng & Anthony Fenton & Derek Kyte & Charles J Ferro & Melanie Calvert & Paul Cockwell & Stephanie J Stringer, 2016. "Health-Related Quality of Life Impacts Mortality but Not Progression to End-Stage Renal Disease in Pre-Dialysis Chronic Kidney Disease: A Prospective Observational Study," PLOS ONE, Public Library of Science, vol. 11(11), pages 1-18, November.
  • Handle: RePEc:plo:pone00:0165675
    DOI: 10.1371/journal.pone.0165675
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    Cited by:

    1. Sarah Elshahat & Paul Cockwell & Alexander P Maxwell & Matthew Griffin & Timothy O’Brien & Ciaran O’Neill, 2020. "The impact of chronic kidney disease on developed countries from a health economics perspective: A systematic scoping review," PLOS ONE, Public Library of Science, vol. 15(3), pages 1-19, March.
    2. Benjamin R Fletcher & Sarah Damery & Olalekan Lee Aiyegbusi & Nicola Anderson & Melanie Calvert & Paul Cockwell & James Ferguson & Mike Horton & Muirne C S Paap & Chris Sidey-Gibbons & Anita Slade & N, 2022. "Symptom burden and health-related quality of life in chronic kidney disease: A global systematic review and meta-analysis," PLOS Medicine, Public Library of Science, vol. 19(4), pages 1-25, April.
    3. Nga T Q Nguyen & Paul Cockwell & Alexander P Maxwell & Matthew Griffin & Timothy O’Brien & Ciaran O’Neill, 2018. "Chronic kidney disease, health-related quality of life and their associated economic burden among a nationally representative sample of community dwelling adults in England," PLOS ONE, Public Library of Science, vol. 13(11), pages 1-12, November.

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